Historic Trauma Cases: Ben Hogan

American golf pro Ben Hogan (1912-1997) was a four-time Professional Golf Association (PGA) Player of the Year and one of only five players to win all four Grand Slam titles at the time of his death. He won four U.S. Opens, two Masters, two PGAs and one British Open between 1946-53. He was also one of only two players to win three of the four current majors in one year when he won the Masters, U.S. Open and British Open in 1953.

He had his best year in 1953 and was ranked third on the all-time wins list of tour golfers with 63 career victories when he died.

Early Life and Career

William Benjamin Hogan was born Aug. 13, 1912, in Dublin, TX, the son of the village blacksmith. Ben was 9 when his father, Chester Hogan, committed suicide.

The fatherless Hogan family lived in near poverty for many years in Fort Worth, TX, where young Ben sold newspapers to help put food on the table. At the age of 12, he turned to caddying, which prompted his early interest in golf, and he first joined the PGA Tour at age 19.

Hogan really had two golf careers - the underwhelming winless years, 1931-39, and the spectacularly successful period from 1940 onward. He was the leading money winner in 1946 and 1948 and had the lowest stroke average in 1940, 1941 and 1948.

The Crash of 1949

The year 1949 promised to be another winning season for Hogan. After competing in the Arizona Open in Phoenix, he and his wife Valerie were driving to their new home in Texas Feb. 2 when heavy fog descended on the West Texas Highway.

As they were crossing a two-lane bridge outside Van Horn, TX, approximately 150 miles east of El Paso, Hogan's car collided head-on with a Greyhound bus, which had swung into his lane to pass a truck. Hogan threw himself over his wife, who was in the passenger seat, to shield her from harm, which saved her from serious injury and probably saved his own life as well.

The impact of the bus drove the car's engine into the driver's seat and the steering wheel into the back seat. While Valerie Hogan received only minor lacerations and contusions, Ben suffered a broken clavicle, fractured ribs, a complex pelvic fracture, facial and eye injuries, a fractured left ankle and a soft-tissue injury to his left leg.

It would take 90 minutes for an ambulance to reach the crash scene. Hogan was taken to a small clinic in Van Horn for X-rays and to have his fractures splinted, and was then taken by ambulance to a hospital in El Paso, a trip that took several hours. He reportedly was delirious during much of the 150-mile trip due to pain exacerbated by traversing mostly dirt roads. Because of his unstable vital signs, the "transport team" withheld analgesics during the transport for fear it would compromise his blood pressure and respiratory status.

Complications Set In

After his fractures were set in El Paso, it appeared Hogan would survive his injuries. Unfortunately, the left leg trauma in addition to a pelvic fracture rendered him completely bedridden, and he subsequently developed deep vein thrombosis (DVT), manifested as swollen, tender legs.

On Feb. 18, Hogan experienced respiratory distress due to a large pulmonary embolus (PE) to the right lung. In 1949, physicians could only offer patients with DVT the option of thinning their blood with plasma and IV fluids. Hogan barely clung to life, suffering recurrent respiratory distress believed to be related to multiple pulmonary emboli.

The only procedure then shown to be effective at limiting the potential life-threatening occurrence of PE was ligation of the inferior vena cava (IVC) to keep large clots from reaching the heart, lungs or brain. This procedure was done only by a few surgeons in select hospital centers. Fortunately for Hogan, Alton Oschner, MD, the premier vascular surgeon of this era, was both a friend and admirer.

Oschner approached the vena cava through a 12-inch abdominal incision and the ligation was performed at the infrarenal cava to prevent any clot from reaching the pulmonary circuit. Ligating the IVC abruptly reduced the blood flow back to the heart. Hogan's blood pressure remained dangerously low until the smaller veins dilated sufficiently to increase the blood flow enough to return normal venous volume to the right side of the heart. In addition, there was no guarantee that a clot would not travel through Hogan's veins as they dilated larger to provide collateral circulation.

Hogan was discharged April 1 from the El Paso hospital. He weighed 120 pounds. (Hogan normally carried 160 pounds on his 5-foot-9-inch frame.)

Trying to Get His Life Back

That summer, Hogan was too weak to swing a club or walk much. He suffered lower extremity fatigue due to venous hypertension as a direct consequence of the caval ligation. Many thought he would never play golf again. But few had his determination and strength of character.

With much fanfare, the 1950 season opened with his return to the tournament scene at Los Angeles. Still very weak, he somehow played well enough to force a playoff with Sam Snead. Snead won the tournament, but the bigger story seemed to be Hogan's return.

Sixteen months after the near-fatal accident, Hogan won the 1950 U.S. Open at Merion Golf Club in Ardmore, PA. His remarkable 1-iron shot on the difficult final hole forced a playoff. The next day, he captured the title by shooting a brilliant 69. In 1951, Hogan retained his U.S. Open title at demanding Oakland Hills Country Club in Bloomfield Hills, MI. He also won his first Masters, shooting a then-record 274.

Hogan was even better in 1953 at the age of 41 when he won five of six tournaments, including three majors - the Masters, U.S. Open and British Open.

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